Provider Demographics
NPI:1871741629
Name:FERNANDEZ, ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 WALNUT STREET
Mailing Address - Street 2:COB 2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5509
Mailing Address - Country:US
Mailing Address - Phone:215-955-1234
Mailing Address - Fax:215-923-6792
Practice Address - Street 1:909 WALNUT STREET
Practice Address - Street 2:COB 2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5509
Practice Address - Country:US
Practice Address - Phone:215-955-1234
Practice Address - Fax:215-923-6792
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2612542084N0400X
PAMD4521672084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03356796Medicaid